[Nurse 1991]

I work full time, on call for a hospice and therefore do a lot of crisis management. I am often frustrated by other R.N.s and L.P.Ns because they do not want to give Roxanol or sometimes other meds because they do not want to "kill" the patient. Last night, a LTC nurse refused to give my patient roxanol when his respirations were at 40.

What resources are available to educate other healthcare providers about morphine use and respiratory distress? How do you explain it when the subject comes up? (I have my explanation, but would like ideas for different phrasing, and approaches.) Since I work only on call I am often educating in the heat of the moment and do not have a relationship with these nurses.

[suebird3]

Have you ever considered doing Inservices for the Facilities you cover? Ask your "higher ups" about that. Bring in literature, etc.

Suebird

[earle58]

Originally Posted by Nurse 1991

I work full time, on call for a hospice and therefore do a lot of crisis management. I am often frustrated by other R.N.s and L.P.Ns because they do not want to give Roxanol or sometimes other meds because they do not want to "kill" the patient. Last night, a LTC nurse refused to give my patient roxanol when his respirations were at 40.

i share your frustration.
i have educated many nurses in its' use(s), how it works and have emphasized the theory of 'intent'.
these same nurses have had sev'l inservices on pain assessment/pain mgmt.
yet there remains too many nurses who will not administer it and orders need to be carefully rewritten.
if a md/np happens to be present and tells a nurse, that the pt needs a dose, then there isn't any problems; as long as the nurse doesn't have to make the decision herself.
sadly, there are still many md's who feel the same way, and start their doses at mso4 2mg sl q6h.
there's much more autonomy at inpatient care facilities.

leslie

[aimeeinorbit]

Originally Posted by Nurse 1991

I work full time, on call for a hospice and therefore do a lot of crisis management. I am often frustrated by other R.N.s and L.P.Ns because they do not want to give Roxanol or sometimes other meds because they do not want to "kill" the patient. Last night, a LTC nurse refused to give my patient roxanol when his respirations were at 40.

What resources are available to educate other healthcare providers about morphine use and respiratory distress? How do you explain it when the subject comes up? (I have my explanation, but would like ideas for different phrasing, and approaches.) Since I work only on call I am often educating in the heat of the moment and do not have a relationship with these nurses.

I am not a hospice nurse, but this is something that comes up more often than I thought it would in acute care. I would like to know what your explanation is. I know this a huge grey area for me and I would like input. Thanks.

[mc3]

The ANA has a position statement on use of morphine in end of life. I think you can go to their web site and get it. I know that HPNA also has a position statement on their website www.HPNA.org. I have both printed out and carry them with me at all times. Really, education, especially an inservice is what's needed. Our hospice MD used to do them. And sadly, even after multiple inservice presentation, some nurses just won't "administer the last dose". I used to ask my hospice MD's to write the order to say "10 mg q2h ATC - Do Not Hold". Still.....
Good luck - sometimes it's very discouraging!
PS If you want to private e-mail me your address, I'll take a copy and mail to you.